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Brent Health and Care Plan

Our five year plan for

Brent residents to be well and live

well

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CONTENTS

1. IntroductionOverview of the national background to this agenda and the approach of Brent within the context of North West London STP

2. The local picture in BrentOverview of purpose, local demographics and financial situation

3. Understanding our population – the health and wellbeing of BrentSummary of health needs in Brent

4. What to expect by 2021 for BrentOutlines what the health economy will look like four years from now

5. What we are doing this year and from 2017/18 onwards in light of North

West London prioritiesSummary of how we will link our activities in Brent to the North West London STP

6. The Brent Health and Care Plan 2017/18 Big Ticket itemsSummary of the ‘Big Ticket’ items in the Brent Health and Care Plan, the initiatives we will build on or develop in Brent and the impact

these will have for Brent patients, carers and residents

Brent is part of the North West London STP, which has nine priority areas.

In Brent we have also developed our own proposals called the Brent

Health and Care plan, which takes into account the priority areas of North

West London, but also takes into account the needs of Brent residents.

The Brent plan offers a five year action plan that will address the triple

aims of:

1. Improving health and wellbeing

2. Improving quality of services

3. Meeting financial challenges

NHS England has published the Five Year Forward View (FYFV) setting

out a vision for the future of the NHS. Local areas have been asked to

develop a Sustainability and Transformation Plan (STP). This plan will

help local organisations to deliver better health and care that will improve

people’s health and wellbeing and the quality of care which people

receive. It will also help local areas to reduce the gap between available

funding and actual cost of meeting demand. This is a new approach

across health and social care to ensure that over the next five years

the focus is on the needs of the place where people live, rather than

individual organisations.

Introduction

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The local picture in Brent

BRENT Health and Care Plan builds on evidence and expertise set

out in the following plans

328, 600 Brent residents1

369,166 GP-registered population2

£406,569k - 2016/17 CCG allocation3

66 GP Practices

14 Nursing Homes

Key Provider Trusts:

• London Northwest Healthcare NHS Trust

• Central and North West London NHS

Foundation Trust

• Brent Community and Voluntary Sector

• NWL STP

• Brent Health Wellbeing

Strategy (2015-2017)

• Brent Better Care Fund

Plan (2016/17)

• Brent Joint Strategic Needs

Assessment

• Brent CCG Portfolio

Roadmap (16/17 – 18/19)

• Public Health Service Plans

• Brent Children & Young

People Mental Health

Transformation Plan

• Brent Children’s Trust

programme

• Brent Council Outcomes-

Based Reviews

(Employment and Housing)

The Brent Health and Care plan aims to bring together providers and

commissioners of care (both Council and NHS), our vibrant voluntary and

community sector, private sector to deliver a genuine plan for Brent through

ongoing engagement with our residents.

Our residents deserve health and care services that are

designed to meet their needs.

Engagement with Brent residents and partners has been

central to the development of the Health and Care Plan. We will

continue to engage with local people on how services are

commissioned and delivered.

The financial situation in Brent

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1: GLA Population Estimate 20162: HSCIC, April 20163: Excludes running costs and carry forward surplus from 15/16

Approximately £12m of net savings are required each year to close the CCG

financial gap over the next five years.

Council will have a £17m gap by 2020 without applying the Council tax precept

and £9m if Brent applied the precept year on year up to 2020.

London North West Healthcare Trust (LNWHT) provides services to three key

CCGs, and therefore only a proportion of its ‘gap’ is directly associated with Brent;

similarly with CNWL (Central & North West London Trust).

Brent’s financial gap by NHS organisation

Organisation

‘Do nothing’

(including no 16/17

savings) by 2020/21

16/17 savings

plans (CIP/QIPP)

Remaining

financial challenge

LNWHT £191.8m £34.4m £157.4m

CNWL £52.9m £14m £38.9m

Brent CCG £58.6m £9.3m £49.3m

Understanding our population – the health and wellbeing of Brent

A Health and Wellbeing Strategy only works if it is based on a proper

understanding of people’s needs. Thanks to an effective partnership

between Brent Council and Clinical Commissioning Group and a

comprehensive needs assessment, we know for example, that:

• Pressures relating to housing or employment have a negative impact

on mental health

• Level of childhood obesity in Brent is higher than the national

average

• Less than half of our residents are getting enough exercise

• Use of tobacco is still too high despite many people being aware of

the risks

• Age-related mental illness is increasing

• People with long term and serious mental health conditions have

lower life expectancies, than they should be

• Social isolation and loneliness is having a detrimental effect on

health and wellbeing

• Too many people feel isolated

• Type 2 diabetes is on the rise

• Lack of widespread and enough support for people to manage

Long-Term Conditions.

Address

Childhood

Obesity

Reduce

Smoking

Prevalence

Increase

Physical

Activity

Help Improve

People’s

Mental Health

Reduce

Social

Isolation

Support to

Manage

LTCs

Address

Incidence of

Diabetes

Improve

Mental Well-

Being

38% of children

aged 10-11 are

classified as

overweight or

obese

The estimated

smoking

prevalence in

Brent is 17% or

14% smoking

prevalence

amongst 18+

Over half the

adult population

in Brent (53%)

take part in no

moderate

intensity sport or

physical activity

for at least 30

minutes duration

a week

The prevalence of

severe and

enduring mental

illness in Brent is

1.1% of the

population

In 2014, an

estimated 33,959

people aged 18 to

64 years were

thought to have a

common mental

health disorder

In 2013/14, only

39% of adult

social care users

in Brent reported

that they have as

much social

contact as they

would like

By 2030, it is

estimated that

nearly 15% of

people aged 16

or over in Brent

will have diabetes

compared to the

predicted England

average of about

9%

• The percentage of

people with

depression,

learning difficulties,

mental health

issues or other

nervous disorders

in employment is

23% - lower than

the England rate

(36%)

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Only 56% of people

with a long-term

condition feel

supported to

manage their

condition

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• Providers will be working more efficiently and effectively to meet the growing demand on services. National and international best practice

is used to reduce the financial gap

• Reduced demand for acute and residential care through a range of initiatives. We will do this through early intervention and prevention;

effective case management of people with complex needs; reduced variation in the management of Long Term Conditions (including Right

Care); enhanced care in Nursing Homes; implementation of ‘discharge to assess’ models; and achieving a unified Frailty and Older

People’s Care model

• Providers will achieve and maintain financial balance by implementing internal financial recovery plans, including the redesign of Central

Middlesex Hospital, reductions in length of stay and reduced reliance on agency staff

• A strong delivery focus to implement the Brent annual priorities on time.

• There is a highly skilled workforce that continues to promote local employment. The workforce is joined up across health and care. Our staff

will have the tools and support they need to deliver the coordinated care that people deserve

• Providers are jointly accountable for quality and outcomes of care. The quality and outcomes of care for people with multiple long term

conditions will improve

• Higher clinical standards and more efficient delivery of care are being achieved. Central Middlesex Hospital for example has huge potential

and we propose to redesign it as a centre of acute care excellence

• Provision of early interventions is prioritised for people with mental health problems and reliance on inpatient care is reduced

• An increasingly integrated approach is being taken to commissioning (and providing) services locally, including nursing care homes, which

will improve quality

• The services older residents depend on are harmonised and unified. They will get high quality of care and support as and when they need it

and will help them to remain active and independent as long as possible.

• Wellbeing is seen in its widest sense. It is not just about healthcare but wider factors such as employment, housing, and lifestyle. Brent will

be a Dementia-Friendly Borough

• Mental and physical health are given equal importance and will be considered holistically at the point of care

• Early intervention and prevention are central to everything we do

• People are better able to self-care and make decisions for themselves concerning their health and wellbeing

• Services people need are as joined up as possible.

What to expect by 2021 for Brent H

ea

lth

&

We

llb

ein

g

Ca

re &

Qu

ali

ty

Fin

an

ce

&

Eff

icie

ncy

Over the next five years we will ensure:

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1. Helping people STAY well, in mind and

body.

We’re helping people take better care of themselves. We’re making sure that every encounter residents have with healthcare

services is a positive and effective experience. We’re also getting serious about prevention – this includes tackling social

isolation; reducing the number of people taking up smoking; helping those who already smoke to quit; and, encouraging

people to drink less alcohol.

2. Helping those disproportionately

affected by cancer, heart disease and

respiratory illness

We’re working with partners across the capital to take forward the London-wide five year commissioning strategy and the

2016/17 North West London improvement plan for cancer services. We’re also helping residents get active and are working

with partners to develop an air quality action plan.

3. Making the management of long term

conditions far more consistent

We’re working to get more people on to Personal Health Budgets. We’re giving people with conditions such as diabetes,

muscular skeletal disorders, cancer, and respiratory problems, confidence that they have access to consistently high quality

services.

4. Making sure residents can access the

services they need at a place and time that

best suits them

We’re transforming Central Middlesex Hospital into a 21st century centre of excellence. We’re making sure that triage and

assessments are clinician-led, and are getting to work implementing agreed plans to improve primary care facilities.

5. Helping those in the latter stages of their

lives live with dignity

We’re putting ‘lead providers’ in place and have them taking responsibility for the delivery of all services across the care

pathway. We’re providing a far better standard of care and quality of service for people approaching the end of their lives.

6. Improve life expectancy for those with

serious and long term mental health needs

We’re getting proactive and are making sure that those in need have the care and support necessary for a full and swift

recovery. We’re completing the implementation of our mental health road map, as well as the North West London ‘Like Minded’

strategy.

We need to do much better for people with mental health illness. We have to reduce reliance on inpatient care. We have to

improve support for older people with serious mental health illnesses. And we’re working to include mental health needs in the

Individual Funding Request Process.

7. Protect the mental and physical health

and wellbeing of children and young

people across the borough

We’re implementing our Child Obesity Strategy. And we’ll continue to implement the Brent Children’s Trust transformation

programme.

8. Universal access to a consistently high

standard of care

We’re working toward government plans for a nation-wide seven day hospital service . We’re carrying out a proper evaluation

of our social care provision. And are designing and implementation a single discharge process across health and social care

services for the whole of the West London Alliance (WLA). We’re also trying to ensure far better coordination with local police

and provide them with 24/7 access to essential services such as those for mental health.

9. Improve consistency in patient

outcomes and experience regardless of

the day of the week that services are

accessed.

• Achieve seven day hospital services with the same standards of care, seven days a week over the next two years

• Evaluate the impact of existing seven day social care provision across the WLA and across health and social care

• Design single discharge process across the WLA and across health and social care

• Improve 24/7 single point of access and rapid response for Mental Health through new links to police.

Pre

ve

nti

on

Inte

gra

tio

nTe

ch

no

log

y &

Inn

ova

tio

n

What we are doing this year (2016/17) and in 2017/18 onwards for the NW London prioritiesConversations are ongoing about post 2016/17 plans against the nine priorities – plans are currently being developed with partners

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Brent Health and Care Plan Big Ticket Items 2016/17 and 17/18 Agreed by the Health and Wellbeing Board.

There are six Big Ticket Items that will have the biggest impact locally on the triple aims.

The Big Ticket Items can only be achieved as a partnership among all agencies responsible for health in Brent working together.

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Big Ticket Item 1 Description Impact

Joined-up services

helping residents get

well and stay well-

prevention

We will help people get well and stay well.

We will also offer advice on staying well in the first place.

We need to make sure that these services are working together

and on the same page.

That way, we can offer the high quality that residents expect

and deserve, and get even better value for money, which is

increasingly essential in the face of on going government cuts.

• Improve outcomes by developing and

targeting services that prevent identified ill-

health issues in Brent

• Reducing alcohol-related admissions

• Supporting people to maintain and improve

their health and wellbeing through social

isolation initiative, reducing admissions and

ambulance call outs

• Offer those at high risk of diabetes intensive

support to reduce their modifiable risk

(primarily through increased physical

activity and improved nutrition).

• The above initiatives have demonstrable

savings and can evidence improved

wellbeing, the details of which will be

developed through the prevention work

stream

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Big Ticket Item 2 Description Impact

New Models of Care-

Greater access to more

effective services

We’re going to make it easier for people to get an appointment

with their GP.

This will mean that the patient and their GP can focus on

working together to get well and stay well.

To make this work, we’ll need to help our GP practices build

better partnerships with one another.

We’ll also need to support this kind of coordinated cooperation

across the spectrum of healthcare service providers.

By supporting this kind of enhanced integration, patients can

expect far better continuity of care and will find that the

services they need are better equipped to properly understand

and address their needs.

As well as reducing unnecessary hospital visits and admissions

this will greatly improve the ‘resident’s experience’ and, most

importantly, help make people feel genuinely better.

• Proactive care through planning, prevention

and integrated care

• Continuity of care through relationships

between the patient their carers and their own

GP

• Care at appropriate time and in the

appropriate setting - out of hospital where

possible

• Reduce inappropriate hospital admissions for

people with long term conditions

• Improved wellbeing and service user

satisfaction.

Brent Big Ticket Items – 2016/17 and 2017/18

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Big Ticket Item 3 Description Impact

Joining up Older

People’s services

We’re going to help our older residents live more active,

engaged, and independent lives, with dignity guaranteed.

As we get older, we need more support to stay healthy. We

want to make sure that the whole of Brent’s healthcare system

is geared up to provide the best possible care as soon as a

need arises. We want to give our residents the peace of mind

of knowing that Brent’s hospitals and clinics are the best in the

world. But we also want to help people stay healthy in order to

keep visits or admissions to an absolute minimum.

As well as reducing pressure on services such as A&E, this

approach will help keep many of our elderly residents happier

and healthier for longer.

• Reduction in A&E conversion rate

(Emergency admission/A&E attendance)

• Reduction in hospital admissions >48 hours

length of stay (LoS) for people over 65

• Reduced LoS for people over 65 in hospitals

• Reduction in readmissions to hospital for

people over 65

• Reduction in A&E attendances for people

over 65

• Reduction in delayed transfers of care

(DTOCs)

• A reduction in adult social care and CHC

spend on care packages

• Increased staff satisfaction

• Improved experience of people over 65

using non elective services.

Brent Big Ticket Items – 2016/17 and 2017/18

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Big Ticket Item 4 Description Impact

Improve outcomes for

people with mental

health illness

We need to better support the needs of children, young people

and adults in Brent who are struggling with their mental health

and wellbeing and do better for those of our older residents

who are at risk of, or suffering with, degenerative conditions

such as dementia. We also need to promote a far higher

societal understanding and awareness of mental health issues,

challenging stigma and confronting prejudicial behaviour.

We have to transform all of these services. We have to get

better at identifying needs sooner and then be ready to

intervene as quickly as possible. As well as being unfair on the

patient, relying on inpatient or crisis-related care is nowhere

near as effective as early intervention.

This is an area where we can and must do better. It’ll take a

team effort, pulling together every resource at the disposal of

everyone involved which, in addition to the council and

healthcare providers, also includes our schools, local police

teams, and the wealth of community groups that we’re

fortunate to have in Brent.

• Reduction in inpatient and residential care

placements

• Reduce length of stay for acute mental health

beds

• Increase provision of health checks

• Increased independent living and people with

mental health needs supported into education

and employment

• Reduction in tier 4 placements

• Wider access to peer support and self referral

services by children and young people.

Brent Big Ticket Items – 2016/17 and 2017/18

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Big Ticket Item 5 Description Impact

Transforming Care –

Supporting People with

learning disability

We’re going to make sure that the services and support that

people with learning disabilities rely upon are better

coordinated, more fully integrated with one another and with

other health and social care services, and of a higher, more

consistent quality across the borough.

We will continue to implement the recommendations of the

Transforming Care and Commissioning Steering Group’s 2014

report on the Winterbourne View scandal.

We’ll help more people get the most out of Personal Health

Budgets and direct payments. And we’ll help reduce the need

for acute and inpatient care and make sure that they can get as

much of the support they need from their GP and in the

community.

This will result in a better standard of care, greater

opportunities for more independent living, including increased

access to employment and educational opportunities, and

reduced pressure on more complex and expensive services.

• Reduce the number of people in inpatient

units and move people into supported living

and or mainstream housing as appropriate

• Reducing care management budget through

supporting people in community settings

• Enhanced take up of personal budgets

• Increase access to employment and

education opportunities

• Improved quality of care and wellbeing.

Brent Big Ticket Items – 2016/17 and 2017/18

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Big Ticket Item 6 Description Impact

Central Middlesex

Hospital (CMH) a centre

of excellence

We’re going to transform Central Middlesex Hospital into a 21st

century centre of excellence, dedicated to improving the health

and wellbeing of Brent’s residents.

The CMH of the future will focus on early intervention and

prevention. It will take a holistic view as the best course of care

and support, giving contributory factors such as employment

and housing the consideration they deserve.

We also want to make sure that local people have the chance

to build and develop the skills and experience needed to

secure good quality jobs in Brent’s health and care economy.

• To improve wider determinants of health

and wellbeing, including employment

• To increase dementia-friendliness of sites,

services and support

• To enable holistic approaches to care and

support

• To have a significant impact on health

prevention, health promotion, self-care and

the beneficial effect of the not-for-profit

sector

• To encourage flexible skills development

and deployment, with a focus on local Brent

residents

• To develop a centre of excellence

• To expand provision of early interventions

for people with mental health problems

• To support unified frailty and older people’s

car

• To reduce acute and residential care

demand.

Brent Big Ticket Items – 2016/17 and 2017/18

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Conclusion

The Brent Health and Care Plan is our plan for Brent residents to be well and live well.

It represents Brent’s overarching five year strategy and implementation plans to improve

the health and wellbeing of Brent residents, the quality of services and care provided, and

to address financial challenges to meet the growing demand.

The Brent Health and Care Plan builds on existing plans, plus new initiatives where gaps in

existing plans have been identified. New initiatives will be subject to further engagement

with Brent residents.

The Brent Health and Care Plan provides:

o A clear shared view of the big priorities for the next five years, particularly the Brent

‘big ticket’ items

o A mechanism for the CCG and Council to track the delivery of Brent’s key

programmes

o A foundation for developing plans for future years beyond 2017/18